Surgical Endoscopy

, Volume 32, Issue 6, pp 2696–2703 | Cite as

Vagus nerve-preserving versus conventional laparoscopic splenectomy and azygoportal disconnection

  • Dou-Sheng Bai
  • Ping Chen
  • Sheng-Jie Jin
  • Jian-Jun Qian
  • Guo-Qing Jiang



Conventional open and conventional laparoscopic splenectomy and azygoportal disconnection (CLSD) result in poor quality of life because of damage to the vagal nerve. We have developed vagus nerve-preserving laparoscopic splenectomy and azygoportal disconnection (VLSD). This study aimed to evaluate whether VLSD is effective and safe, and to determine whether a reduction in the incidence of postoperative complications improves postoperative quality of life compared with CLSD.


We retrospectively evaluated outcomes in 72 cirrhotic patients with portal hypertensive bleeding and secondary hypersplenism who underwent CLSD (n = 40) or VLSD (n = 32) between April 2015 and December 2016. Their demographic, intraoperative, and postoperative variables were compared.


No patients required conversion to laparotomy in CLSD and VLSD. There was no difference in estimated intraoperative blood loss, volume of intraoperative blood transfused, time to first flatus, time to off-bed activity, and postoperative hospital stay between the two groups. VLSD was associated with a shorter operation time (P = 0.020) and less postoperative complications (P < 0.0001), including less diarrhea (P < 0.0001), epigastric fullness (P < 0.0001), and delayed gastric emptying (P < 0.0001), compared with CLSD. With VLSD, there was a significant increase in body weight and plasma albumin levels at 6 months postoperatively compared with preoperative values (all P < 0.05). The curative effect of improving esophageal/gastric variceal bleeding was similar in the groups.


VLSD is effective and safe for reducing the incidence of postoperative complications, contributing to improving postoperative quality of life.


Liver cirrhosis Portal hypertension Laparoscopy Delayed gastric emptying Vagus nerve 



This work was supported by the Scientific Research Subject of Jiangsu Province Health Department (No. H201661) and the Project of Invigorating Health Care through Science, Technology and Education: Jiangsu Provincial Medical Youth Talent (QNRC2016331).

Compliance with ethical standards


Drs. Dou-Sheng Bai, Ping Chen, Sheng-Jie Jin, Jian-Jun Qian, and Guo-Qing Jiang have no conflicts of interest or financial ties to disclose.


  1. 1.
    Yu H, Guo S, Wang L, Dong Y, Tian G, Mu S, Zhang H, Li D, Zhao S (2016) Laparoscopic splenectomy and esophagogastric devascularization for liver cirrhosis and portal hypertension is a safe, effective, and minimally invasive operation. Laparoendosc Adv Surg Tech A 26:524–530CrossRefGoogle Scholar
  2. 2.
    Bai DS, Qian JJ, Chen P, Yao J, Wang XD, Jin SJ, Jiang GQ (2014) Modified laparoscopic and open splenectomy and azygoportal disconnection for portal hypertension. Surg Endosc 28:257–264CrossRefPubMedGoogle Scholar
  3. 3.
    Zhe C, Jian-wei L, Jian C, Yu-dong F, Ping B, Shu-guang W, Shu-guo Z (2013) Laparoscopic versus open splenectomy and esophagogastric devascularization for bleeding varices or severe hypersplenism: a comparative study. J Gastrointest Surg 17:654–659CrossRefPubMedGoogle Scholar
  4. 4.
    Zheng X, Liu Q, Yao Y (2013) Laparoscopic splenectomy and esophagogastric devascularization is a safe, effective, minimally invasive alternative for the treatment of portal hypertension with refractory variceal bleeding. Surg Innov 20:32–39CrossRefPubMedGoogle Scholar
  5. 5.
    Kim HH, Park MI, Lee SH, Hwang HY, Kim SE, Park SJ, Moon W (2012) Effects of vagus nerve preservation and vagotomy on peptide YY and body weight after subtotal gastrectomy. World J Gastroenterol 18:4044–4050CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Murakami H, Matsumoto H, Kubota H, Higashida M, Nakamura M, Hirai T (2013) Evaluation of electrical activity after vagus nerve-preserving distal gastrectomy using multichannel electrogastrography. J Smooth Muscle Res 49:1–14CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Jiang G, Qian J, Yao J, Wang X, Jin S, Bai D (2014) A new technique for laparoscopic splenectomy and azygoportal disconnection. Surg Innov 21:256–262CrossRefPubMedGoogle Scholar
  8. 8.
    Jiang GQ, Bai DS, Chen P, Qian JJ, Jin SJ, Yao J, Wang XD (2014) Modified laparoscopic splenectomy and azygoportal disconnection combined with cell salvage is feasible and might reduce the need for blood transfusion. World J Gastroenterol 20:18420–18426CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Tomita R, Fujisaki S, Tanjoh K, Fukuzawa M (2000) Relationship between gastroduodenal interdigestive migrating motor complex and quality of life in patients with distal subtotal gastrectomy for early gastric cancer. Int Surg 85:118–123PubMedGoogle Scholar
  10. 10.
    Tomita R, Tanjoh K, Fujisaki S (2004) Novel operative technique for vagal nerveand pyloric sphincter-preserving distal gastrectomy reconstructed by interposition of a 5 cm jejunal J pouch with a 3 cm jejunal conduit for early gastric cancer and postoperative quality of life 5 years after operation. World J Surg 28:766–774CrossRefPubMedGoogle Scholar
  11. 11.
    Adams JF (1967) The clinical and metabolic consequences of total gastrectomy. I. Morbidity, weight, and nutrition. Scand J Gastroenterol 2:137–149CrossRefPubMedGoogle Scholar
  12. 12.
    Tomita R, Fujisaki S, Tanjoh K, Fukuzawa M (2001) Operative technique on nearly total gastrectomy reconstructed by interposition of a jejunal J pouch with preservation of vagal nerve, lower esophageal sphincter, and pyloric sphincter for early gastric cancer. World J Surg 25:1524–1531CrossRefPubMedGoogle Scholar
  13. 13.
    Tomita R, Fujisaki S, Tanjoh K, Fukuzawa M (2003) Studies on gastrointestinal hormone and jejunal nterdigestive migrating motor complex in patients with or without early dumping syndrome after total gastrectomy with Roux-en-Y reconstruction for early gastric cancer. Am J Surg 185:354–359CrossRefPubMedGoogle Scholar
  14. 14.
    Kojima K, Yamada H, Inokuchi M, Kawano T, Sugihara K (2008) Functional evaluation after vagusnerve-sparing laparoscopically assisted distal gastrectomy. Surg Endosc 22:2003–2008CrossRefPubMedGoogle Scholar
  15. 15.
    Kim SM, Cho J, Kang D, Oh SJ, Kim AR, Sohn TS, Noh JH, Kim S (2016) A randomized controlled trial of vagus nerve-preserving distal gastrectomy versus conventional distal gastrectomy for postoperative quality of life in early stage gastric cancer patients. Ann Surg 263:1079–1084CrossRefPubMedGoogle Scholar
  16. 16.
    Datta J, Williams NN, Conway RG, Dempsey DT, Morris JB (2014) Rescue pyloroplasty for refractory delayed gastric emptying following esophagectomy. Surgery 156:290–297CrossRefPubMedGoogle Scholar
  17. 17.
    Shimoda M, Kubota K, Katoh M, Kita J (2013) Effect of billroth II or Roux-en-Y reconstruction for the gastrojejunostomy on delayed gastric emptying after pancreaticoduodenectomy: a randomized controlled study. Ann Surg 257:938–942CrossRefPubMedGoogle Scholar
  18. 18.
    Hanna MM, Gadde R, Allen CJ, Meizoso JP, Sleeman D, Livingstone AS, Merchant N, Yakoub D (2016) Delayed gastric emptying after pancreaticoduodenectomy. J Surg Res 202:380–388CrossRefPubMedGoogle Scholar
  19. 19.
    Jiang XZ, Zhao SY, Luo H, Huang B, Wang CS, Chen L, Tao YJ (2009) Laparoscopic and open splenectomy and azygoportal disconnection for portal hypertension. World J Gastroenterol 15:3421–3425CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Xin Z, Qingguang L, Yingmin Y (2009) Total laparoscopic versus open splenectomy and esophagogastric devascularization in the management of portal hypertension: a comparative study. Dig Surg 26:499–505CrossRefPubMedGoogle Scholar
  21. 21.
    Jiang GQ, Chen P, Qian JJ, Yao J, Wang XD, Jin SJ, Bai DS (2014) Perioperative advantages of modified laparoscopic vs open splenectomy and azygoportal disconnection. World J Gastroenterol 20:9146–9157PubMedPubMedCentralGoogle Scholar
  22. 22.
    Isozaki H, Okajima K, Momura E, Ichinona T, Fujii K, Izumi N, Takeda Y (1996) Postoperative evaluation of pylorus-preserving gastrectomy for early gastric cancer. Br J Surg 83:266–269CrossRefPubMedGoogle Scholar
  23. 23.
    Ihasz M, Griffith CA (1981) Gallstones after vagotomy. Am J Surg 141:48–50CrossRefPubMedGoogle Scholar
  24. 24.
    Hibbard ML, Dunst CM, Swanström LL (2011) Laparoscopic and endoscopic pyloroplasty for gastroparesis results in sustained symptom improvement. J Gastrointest Surg 15:1513–1519CrossRefPubMedGoogle Scholar
  25. 25.
    Binswanger RO, Aeberhard P, Walther M, Vock P (1978) Effect of pyloroplasty on gastric emptying: long term results as obtained with a labelled test meal 14–43 months after operation. Br J Surg 65:27–29CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of Hepatobiliary SurgeryClinical Medical College of Yangzhou UniversityYangzhouChina

Personalised recommendations